System and method for modifying documents sent over a communications network

ABSTRACT

On-line health education includes displaying composites of personalized health content and patient-selected entertainment. Suitable sources of entertainment include generally available web pages and television programs. Composites are spatial (for page displays) or temporal (for image sequence displays). Health content is customized to health and personal situations of individual patients, and replaces advertisements. Composites are generated on a central server in communication with an entertainment server and a health server. Amenable diseases or behaviors include diabetes, asthma, hypertension, cardiovascular disease, eating disorders, HIV, mental health disorders, smoking, and alcohol and drug abuse.

RELATED APPLICATION DATA

This invention is a continuation of Ser. No. 11/301,331 filed on Dec.13, 2005, which is a continuation of Ser. No. 09/540,482 filed on Mar.31, 2000, now abandoned, which is a continuation of Ser. No. 09/394,219,filed on Sep. 13, 1999, now U.S. Pat. No. 6,375,469, which is acontinuation of Ser. No. 08/814,293 filed on Mar. 10, 1997, now U.S.Pat. No. 5,951,300, which are each incorporated by reference in theirentirety.

FIELD OF THE INVENTION

This invention relates to the field of health education, and inparticular to an on-line system and method for displaying to a patient acomposite of patient-selected entertainment content and personalizededucational health content.

BACKGROUND OF THE INVENTION

The health care community has recognized in recent years the importanceof preventive care in managing patients' health. Preventive care isimportant for managing the health of patients having chronic diseases orlong-term conditions, as well as for reducing the incidence ofundesirable behavior (e.g., smoking) in at-risk patients. Preventivecare includes educating patients about diseases and/or healthconsequences of behavior, ensuring communication between patients andhealth care providers (e.g., doctors), and providing patients with toolsand/or treatments for managing diseases or behaviors.

Commonly used preventive care approaches suffer from several drawbacks.Much of preventive care is voluntary, and thus a large fraction ofpreventive care resources is typically spent on patients who activelyseek involvement in their care. A large number of patients do notactively seek information and treatment in the absence of symptoms.Also, health care providers receive very little information on whetherpatients are complying with preventive care guidelines. Thus, healthcare providers often are not able to take remedial steps before thedisease affects patients symptomatically (e.g., through pain). Reachingpassive patients and people at risk for developing medical conditions iscritical to delivering effective preventive care.

The mass-marketing techniques used for health education by most healthmaintenance organizations (HMOs) and insurance companies allow littlecustomization of information to an individual patient's needs.Consequently, many patients may not directly identify with theeducational approaches used by their health care providers.Personalizing health education would significantly raise theeffectiveness of preventive health care, especially in children andadolescents.

In U.S. Pat. No. 5,542,420, Goldman et al. describe a system forprescribing personalized diets to individual patients. Health profilesof the patients are used to generate the personalized diets. The systemdescribed by Goldman et al. requires patient initiative in theprescription process.

In U.S. Pat. No. 5,140,419, Galumbeck et al. describe amultiple-hierarchical data delivery system capable of addressingreceivers singly or in groups. The Galumbeck et al. patent does notdiscuss health education issues. Other related to selective addressingof receivers include U.S. Pat. Nos. 5,565,909 and 5,432,542 by Thibadeauet al., and U.S. Pat. No. 4,264,924 and U.S. Pat. No. 4,264,925 byFreeman et al.

None of the above-mentioned disclosures provides a system or methodcapable of delivering personalized health information to a patient,without requiring an express request for the information by the patient.

OBJECTS AND ADVANTAGES OF THE INVENTION

Accordingly, it is a primary object of the present invention to providea system and method for delivering personalized health content to apatient, without requiring specific patient requests for the healthcontent. The system allows delivering personalized health content in thecourse of normal recreational activities of the patient. Personalizingthe health content improves the educational effectiveness of the method.The system allows the use, without substantial modification, ofpre-existing spatial or temporal layouts of entertainment programming.The use of a dedicated server for data processing and storage allows areduction in the amount of data transferred over relativelylow-bandwidth communication lines to patients' homes.

SUMMARY OF THE INVENTION

A system for delivering personalized health information comprises asource of personalized health content, a source of entertainmentcontent, a composing means in communication with the sources ofentertainment and personalized health content, and a display means incommunication with the composing means The composing means generates acomposite of entertainment content and personalized health content. Thedisplay means generates a display of the composite.

The source of entertainment content is in communication with a contentrequest means for allowing the patient to expressly request specificentertainment content, i.e. to “pull” content from the source ofentertainment content. The entertainment content is delivered to thecomposing means following an express patient request for theentertainment content

The source of personalized health content comprises a health contentselection means in communication with a set of inputs. The healthcontent selection means generates the personalized health contentaccording to data from the set of inputs. The set of inputs comprises ageneral health content base and inputs allowing the selection of contentfrom the general health content base. Inputs used for content selectioninclude a medical treatment regimen, a health profile, an educationaltreatment plan, a psychological profile, and a content history of thepatient. A treatment plan means generates the educational treatment planfrom the treatment regimen and health profile of the patient.

The medical treatment regimen specifies target health parameters, whilethe health profile specifies actual health parameters of the patient.The treatment plan is generated by comparing the target parameters tothe actual parameters. The treatment plan specifies educational goalparameters of the patient. The educational goal parameters measure theimportance of corresponding educational goals for the particularpatient. The psychological profile comprises data characterizing likes,dislikes, and motivators of the patient. The content history identifiesthe health content to which the patient has been exposed within a giventime period.

The composing means generates the composite according to a patientcriticality. The patient criticality measures the patient's compliancewith the treatment regimen. A criticality means generates the patientcriticality by comparing the treatment regimen and the health profile.

The composite is preferably a spatial composite. That is, the compositecomprises a composite page including both entertainment and healthcontent. The composite page comprises an entertainment sectioncomprising the entertainment content and a health section comprising thehealth content. The source of entertainment content generates anoriginal page comprising an entertainment section and an undesirablesection (e.g., an advertisement). The composing means replaces theundesirable section with a health section, thereby generating thecomposite page. The page layout of the composite page is substantiallyidentical to the page layout of the original page. A spatial compositepreferably comprises a hypertext markup language (HTML) document.

In an alternative embodiment suited for television health education, thecomposite is a temporal composite. The display of the composite thencomprises an image sequence comprising a first image and a second image,wherein the first image comprises the entertainment content and thesecond image comprises the health content. The first image consistssubstantially of the entertainment content, while the second imageconsists substantially of the health content.

The system comprises a client subsystem comprising the display means,and a server subsystem in communication with the client, subsystem overa remote network. The display means preferably comprises a televisionset and a multimedia processor. Suitable remote networks include theInternet and communications lines used for cable television delivery.The server subsystem preferably comprises the composing means and theentertainment and health content sources. The server subsystem, and inparticular the source of health content, is in communication with aplurality of client subsystems, where each client subsystem correspondsto a different patient, and where data is customized (personalized)independently for each client subsystem.

The present invention further provides a method of delivering healthinformation to a patient. The method comprises the steps of generatingthe composite of personalized health content and patient-requestedentertainment content, and displaying the composite to the patient.

DESCRIPTION OF THE FIGURES

FIG. 1 is a high-level block diagram illustrating the operation of asystem of the present invention.

FIG. 2 illustrates the generation of a composite page by substitution ofa health section for an undesirable section in an original page,according to the present invention.

FIG. 3-A is a block diagram illustrating a preferred method ofgenerating a patient criticality and personalized health content,according to the present invention.

FIG. 3-B is a block diagram exemplifying structures for a medicaltreatment regimen, health profile, and educational treatment plan for adiabetes patient, according to the present invention.

FIG. 3-C is a block-diagram exemplifying preferred structures for ageneral health content base, psychological profile, and content history,according to the present invention.

FIG. 4-A shows preferred hardware and connections for a system of thepresent invention.

FIG. 4-B shows an alternative arrangement of hardware according to asystem of the present invention.

DETAILED DESCRIPTION

In the following description, a source of content is understood toinclude a record of the content (e.g., a HTML file), or hardware used tostore the content (e.g., a server). Personalized health content isunderstood to refer to health content that is personalized to anindividual patient's health situation, and not merely to a healthsituation of a generic patient having a given disease. In a system fordelivering health information to a plurality of patients, personalizedhealth content is understood to refer to health content customizedindividually for each patient. The statement that an input is incommunication with some data processing means is understood to mean thatthe data processing means is adapted to use (directly or indirectly)data specified by the input. The term server is understood to refer toan information-generating device capable of communicating with aplurality of clients; servers include computer servers and televisiondelivery systems. The term patient is understood to refer to personssuffering from a condition or disease, as well as persons at risk forengaging in behavior having adverse health consequences.

The following discussion will focus on a computer-based implementationof a system and method for diabetes preventive health care. It will beclear to the skilled artisan that the present invention is suitable forpreventive care directed to many other health conditions. Moreover,there are many well known structures, interfaces and processes that aresuitable for implementing the present invention.

FIG. 1 illustrates generally a health information delivery system of thepresent invention. A source of entertainment content 20 and a source ofpersonalized health content 22 are in communication with a composingmeans 24, which in turn is in communication with a display means 26.Source 20 generates entertainment content 30, while source 22 generatespersonalized health content 32. Composing means 24 generates a compositedocument 34 comprising entertainment content 30 and personalized healthcontent 32. Display means 26 generates a display 36 of compositedocument 34. A patient criticality or criticality data 40 is used bycomposing means 24 to modulate the relative display importance of healthcontent 32 within display 36.

Preferably, entertainment content 30 comprises a hypertext markuplanguage (HTML) document requested by the patient under treatment.Personalized health content 32 comprises an HTML document encoding apersonalized educational health message, while composing means 24comprises computer software. Composite document 34 is preferably a HTMLfile. Display means 26 comprises computer software (e.g., a browser)capable of generating displays of HTML documents. It will be apparent tothe skilled artisan that, in general, many formats other than HTML areavailable for entertainment content 30, personalized health content 32,and composite document 34.

The composite is preferably a spatial composite. That is, entertainmentand health content are displayed within the same composite page orimage. FIG. 2 illustrates the generation of a spatial compositeaccording to a preferred embodiment of the present invention. Aconventional HTML entertainment document comprises an original page 100.Original page 100 comprises an entertainment section 102 and anundesirable section 104. Page 100 is a conventional web page such as ahome page of a company or information provider. Undesirable section 104comprises an advertisement not requested by the patient, or otherinformation targeted for replacement.

Composing means 24 uses page 100 and a health section 106 to generate apage 108. Composite page 108 comprises an entertainment section 112 anda composite health section 116. Preferably, entertainment section 112 isidentical to entertainment section 102. Composing means 24 thusessentially replaces undesirable section 104 with health section 116.Health section 116 is preferably formatted to have substantially thesame size as undesirable section 104, such that the page layout ofcomposite page 108 is similar to the page layout of original page 100.Health section 116 comprises a link to further information related tothe subject of health section 116; the patient accesses the link byclicking on health section 116. In an alternative embodiment (notillustrated), a composite page is generated by adding a health sectionto an original page, without removing any undesirable section from theoriginal page.

Generating page sections of predetermined size using HTML is well knownin the art. Generating HTML composites and recognizing advertisingsections of HTML documents are described in detail in theabove-incorporated U.S. patent application “System and Method forModifying Documents Sent Over a Communications Network.”

Criticality data 40 modulates the mixing of entertainment section 102and health section 106. Criticality data 40 measures the patient'scompliance with a doctor-prescribed treatment regimen. Criticality data40 modulates the relative display importance of section 116 within page108. The relative display importance preferably includes the probabilitythat undesirable section 104 is replaced by health section 116. For apatient managing his or her health successfully, composite page 108 mayinclude a limited number of health sections 116 and a relatively largenumber of advertising sections. For a patient not in compliance with thetreatment regimen, composite page 108 includes a large number of healthsections 116. In another embodiment, relative display importanceincludes the size and placement of health section 116 within page 108;the page layout of composite page 108 is then generally different fromthe page layout of original page 100.

FIG. 3-A illustrates the steps used to generate personalized healthcontent 32 in a preferred embodiment of the present invention. Source 22of personalized health content 32 comprises a health content selectionmeans 200 in communication with a set of inputs. The set of inputsprovides data for generating personalized health content 32.

The set of inputs of selection means 200 comprises a base 222 of generalhealth content 222. General health content 222 is generated and updatedusing research on communicating health information. The general healthcontent base is preferably a large database of messages comprisingvideo, audio, hypertext, and/or text-to-speech data. Each element of thegeneral health content base comprises a message and a messagecharacterization, as illustrated in FIG. 3-C. The messagecharacterization comprises an explicit or implicit description of themessage. In particular, the message characterization comprisesinformation on the treatment plans and psychological and/or healthprofiles for which the message is suitable or effective. In a preferredembodiment, the message characterization comprises tags indicating theeffectiveness of the corresponding message for given treatment plan,psychological profile, and health profile parameters.

The set of inputs of selection means 200 comprises a patientpsychological profile 220, as shown in FIG. 3-A. Psychological profile220 contains information about the patient's psychology, including hisor her likes, dislikes, and motivators. For example, psychologicalprofile 220 includes parameters characterizing the patient's response tovarious motivating factors such as love of family or fear of adversehealth consequences, and the patient's interest for cultural or artisticsubjects such as football or jazz music. The data of psychologicalprofile 220 is gathered from tests of the patient, from questionnaires,and by monitoring the patient's usage of the system. Psychologicalprofile 220 records the subjects corresponding to the health sections onwhich the patient has requested information (by clicking on thesections).

Selection means 200 compares parameters of psychological profile 220with corresponding parameters of message characterizations. Selectionmeans 200 then tends to select for display messages which fit thepatient's psychological profile. For example, for a diabetes patientmotivated by fear of adverse future health consequences, selection means200 is likely to select messages describing long term adverse healthconsequences (e.g., blindness, amputation) resulting from poor diabeteshealth care. For a patient motivated by money, selection means 200 tendsto select messages that communicate the financial benefits ofmaintaining blood glucose levels within prescribed ranges. For a patientmotivated by love of family, selection means 200 tends to selectmessages emphasizing the importance of proper care to the patient'sfamily. In general a patient responds to a plurality of motivationalfactors.

The set of inputs further comprises a medical treatment regimen 202.Treatment regimen 202 preferably comprises a set of doctor-prescribedtarget health parameters for the patient.

For a diabetes patient, such parameters include target range of bloodglucose levels, weight, exercise times, parameters characterizing thepatient's diet, and recommended period between doctor checkups.

The set of inputs further comprises a health profile 204 of the patient.Health profile 204 comprises a set of actual health parameters of thepatient. At least some of the actual health parameters defined by healthprofile 204 correspond to the target health parameters of treatmentregimen 202. For a diabetes patient, health profile 204 includes ahistory of the patient's blood glucose reading, as well as the patient'sweight, age, date of last doctor checkup, and other information relevantto the patient's health. Suitable parameters for characterizing diseasesother than diabetes can be readily determined by an artisan of averageskill.

A criticality means 205 generates criticality 40 by comparing treatmentregimen 202 and health profile 204. Preferably, criticality 40 comprisesa criticality index that measures differences between actual healthparameters of the patient (as reflected in health profile 204) andcorresponding recommended health parameters of the patient (asdetermined from treatment regimen 202). For example, for a diabetespatient the criticality index increases if the patient's current bloodglucose reading is not within a prescribed range, or if the period sincethe patient's last doctor checkup is longer than the recommended periodbetween doctor checkups. Exact dependencies of criticality indices onactual and recommended health parameters can be readily determined bythe skilled artisan according to the disease under treatment and themedical data available for the patient.

A treatment plan means 206 generates an educational treatment plan 208from treatment regimen 202 and health profile 204. FIG. 3-B illustratesschematically an example of the generation of an educational treatmentplan for a diabetic patient. Educational treatment plan 208 is aneducational prescription customized to the patient's current healthsituation. Educational treatment plan 208 includes a set of parameterscharacterizing the importance of various health goals for the treatmentof the patient. For example, if the patient's blood glucose readings arehigher than the range prescribed by the patient's doctor (specified byregimen 202), an important educational goal of treatment plan 208 is tomotivate the patient to reduce his or her blood glucose levels.

Educational treatment plan 208 is an input for health content selectionmeans 200. Health content selection means 200 compares parameters ofeducational treatment plan 208 with corresponding parameters of messagecharacterizations. Selection means 200 then tends to select messageswhich fit the patient's educational treatment plan 208. For example, ifa goal of treatment plan 208 is to motivate the patient to reduce his orher blood glucose level, selection means 200 tends to select messagesrelating to blood glucose level.

The set of inputs of selection means 200 further comprises a contenthistory 224 of the patient. Content history 224 keeps track of whichmessages the patient has seen, and whether the patient requestedadditional information in response to each message. Content history 224allows the delivery of complementary and non-repetitive messages to thepatient, over time. Some content is designed to be delivered over aseries of messages. Content history 224 allows the delivery ofpredetermined sequences of messages, and in particular of contentdesigned to be delivered over time. Content history 224 is used toupdate psychological profile 220 according to the subjects of themessages in response to which the patient has requested additionalinformation.

FIG. 3-C illustrates an example of the selection by selection means 200of a message from general health content base 222. Selection means 200preferably compares the message characterizations of each message to thedata characterizing a patient profile, and selects for composingmessages whose characterizations match the patient profile. The patientprofile includes the patient's educational treatment plan 208, contenthistory 224, and health and psychological profiles 204 and 220,respective.

FIG. 4-A illustrates the hardware and connections in a system fordelivering personalized health information, according to a preferredembodiment of the present invention. The system comprises a clientsubsystem 300 located at the patient's home, and a server subsystem 302capable of communication over a remote network with client subsystem300. The remote network preferably comprises a communications line 304conventionally used for delivery of cable television programming.Preferably, server subsystem 302 is in communication with a plurality ofdifferent client subsystems 300. The information delivered by serversubsystem 302 is individually personalized for each client subsystem300.

Client subsystem 300 comprises display means 26 for a particularpatient. Display means 26 preferably includes a television set 306connected to a multimedia processor 308. A patient identification means310 is capable of communication with multimedia processor 308. Patientidentification means 310 comprises a data-bearing card, or “smart card”.Multimedia processor 308 has a receiving slot 312 for receiving card310. Card 310 contains an encrypted patient code identifying thepatient, as well as an address of server subsystem 302 for allowingclient subsystem 300 to connect to server subsystem 302. The addresspreferably comprises a URL address.

A patient feedback means is in communication with multimedia processor308. The patient feedback means preferably comprises a keyboard 320. Thepatient feedback means allows the patient to request a specificentertainment page, by transmitting to server subsystem 302 the URLaddress of the entertainment page. The patient feedback means alsoallows the patient to update psychological profile 220 and healthprofile 204.

Server subsystem 302 preferably comprises an entertainment server 330for generating entertainment content, a health server 332 comprisinginputs for generating health data on the patient, and a central server334 for generating personalized health content and the composite ofentertainment and personalized health content. Health server 332 ispreferably a database located at the patient's health care provider.Health server 332 contains the patient's health profile, standards ofcare for the patient's disease, and the medical treatment regimenprescribed by the patient's doctor. Central server 334 is connected toentertainment server 330 and health server 332 over the Internet.Central server 334 is connected to multimedia processor 308 overcommunications line 304.

The patient feedback means sends to central server 334 a request for anentertainment document (e.g., an HTML file) located on entertainmentserver 330. The entertainment document is any document generallyavailable to the patient. For a page-based implementation, suitableentertainment documents include home pages of companies ororganizations, Internet directories, and pages containing sports news orstock quotes. Central server 334 retrieves the entertainment documentfrom entertainment server 330 and generates a composite document bysplicing a health message into the entertainment document as describedabove. Central server 334 then sends the composite document to displaymeans 26 for display.

FIG. 4-B illustrates the hardware and connections in an alternativeembodiment of the present invention. The display means comprises acomputer 400 and conventional browsing software (e.g., the Navigator®from Netscape Communications) installed on computer 400. The composingmeans comprises an extension to the browsing application. A clientsubsystem 402 comprises computer 400, while a server subsystem 404comprises an entertainment server 406, a central server 408 and a healthserver 410. Client subsystem 402 comprises the display and composingmeans, while server subsystem 404 comprises the sources of entertainmentand personalized health content.

In yet another embodiment of the present invention, the display meanscomprises a conventional television set connected to a cable televisiondelivery system capable of delivering individualized programming to eachof the system's subscribers. The source of entertainment contentcomprises a television program, while the source of personalized healthcontent comprises a personalized educational health message. Thecomposing means comprises conventional equipment suitable for splicingthe health message within the television program. In such atelevision-based implementation, the composite is preferably a temporalcomposite. That is, the composite display comprises an image sequence,with the entertainment and health content displayed within distinctimages.

It will be clear to one skilled in the art that the above embodiment maybe altered in many ways without departing from the scope of theinvention. Various relative arrangements of inputs and processing meansare suitable for generating personalized health content. The patientcriticality can be used as an input for the health content selectionmeans. Various diseases or behaviors are amenable to preventive careaccording to a method of the present invention, including asthma,hypertension, cardiovascular disease, eating disorders, HIV, mentalhealth disorders, smoking, and drug or alcohol abuse. Personalizing thehealth content can be achieved in the process of generating (rather thanselecting) the health content. The health content need not contain onlypredetermined educational messages; suitable health content includesdata from the patient's health profile. Accordingly, the scope of theinvention should be determined by the following claims and their legalequivalents.

1. A system for generating documents, said system comprising: a serverconfigured to (i) receive a first content and a second content and (ii)compose one or more documents using said first content and said secondcontent; and a processor unit configured to receive said one or moredocuments from said server via at least one communication network anddisplay said one or more documents.
 2. The system according to claim 1,further comprising an input device configured to present a contentrequest via the at least one communication network, wherein said serverreceives said first content based upon said content request.
 3. Thesystem according to claim 1, wherein said first content comprisesentertainment content.
 4. The system according to claim 1, wherein saidfirst content comprises markup language.
 5. The system according toclaim 3, wherein said first content comprises hypertext markup language(HTML).
 6. The system according to claim 5, wherein said hyper-textmark-up language (HTML) comprises code for one or more types of contentselected from the group consisting of home pages of companies, homepages of organizations or information providers, internet directories,sports news pages and stock quotation pages.
 7. The system according toclaim 1, wherein said at least one communication network comprises acomputer network.
 8. The system according to claim 1, wherein said atleast one communication network comprises a cable network.
 9. The systemaccording to claim 1, wherein said second content compriseshealth-related material.
 10. The system according to claim 9, whereinsaid health-related material is personalized to an individual based onprofile data.
 11. The system according to claim 10, wherein said profiledata comprises one or more types of data selected from the groupconsisting of a medical treatment regimen, a health profile, aneducational treatment plan, a psychological profile, educational goals,content history and a patient history.
 12. The system according to claim11, wherein said psychological profile comprises one or more types ofinformation selected from the group consisting of (i) informationgathered from tests of said individual, (ii) information gathered fromquestionnaires and (iii) information gathered by monitoring usage of thesystem.
 13. The system according to claim 12, wherein said informationgathered by monitoring usage of the system is gathered by recordingsubjects corresponding to material clicked on.
 14. The system accordingto claim 10, further comprising a health content selector configured topresent said health-related material based on (i) general healthcontent, (ii) a psychological profile, (iii) a content history and (iv)a treatment plan.
 15. The system according to claim 14, furthercomprising a treatment plan determiner configured to present saidtreatment plan based on (i) a medical treatment regimen and (ii) ahealth profile.
 16. The system according to claim 14, further comprisinga general health content base configured to present said general healthcontent based on (i) a psychological profile, (ii) a content history,(iii) a treatment plan and (iv) a health profile.
 17. The systemaccording to claim 14, further comprising a criticality determinerconfigured to present information for formatting said health-relatedmaterial based on (i) a treatment regimen and (ii) a health profile. 18.The system according to claim 11, further comprising an input deviceconfigured to receive feedback from said individual, wherein saidfeedback is used to update one or more types of data selected from thegroup consisting of said health profile, said psychological profile andsaid content history.
 19. The system according to claim 1, furthercomprising a television display coupled to said processor unit andconfigured to display said one or more documents.